By Matayo Baluku, Twaibu Warnala & Denis Muhangi

Globally, an estimated 275 million people used drugs at least once in 2016, 10.9 million of whom injected their drugs. Injecting drugs carries a high risk of human immunodeficiency virus (HIV) and viral hepatitis transmission if sterile injecting equipment is not easily accessible and injecting equipment is shared among users. In 2016, more than half of the people who inject drugs (PWID) worldwide were living with hepatitis C virus (HCV); one in eight was living with HIV, and 82.4% were co-infected with both HIV and HCV. The risk of acquiring HIV for PWID in 2017 was 22 times higher than that for people who did not inject drugs.

Whereas hepatitis B virus (HBV) and HIV are transmitted via blood or body fluids, sharing injecting equipment poses the greatest risk of HCV transmission among PWID. Also, whereas there is no increased risk of HCV transmission in a long-term heterosexual relationship, the risk of transmission increases with multiple sexual partners and among women who are infected with HIV or other sexually transmitted diseases. Similarly, engaging in sex work, younger age, cocaine injecting, depression, requiring help injecting, having unsafe sex with a regular partner, and having an HIV-positive sexual partner are associated with HIV infection among PWID.

Risk factors for HCV among PWID include sharing needles and other injecting equipment, longer duration of injecting career, increased frequency of injection, requiring help injecting, being female, and history of imprisonment.

Despite the heavy burden of injecting drug use and its associated risks, and burden of HIV and HCV among PWID, effective harm reduction interventions that can help prevent their spread are severely lacking in many countries including Uganda. In Sub-Saharan Africa, only eight countries operate the needle and syringe program (NSP); seven offer some form of opioid substitution therapy (OST), and ten have explicit support for harm reduction contained in national policy documents. The current policies and guidelines for prevention and treatment of HIV and AIDS in Uganda do not support OST and NSP.

While Uganda is one of the 179 countries where injecting drug use is present, data on PWID is limited. No studies have enquired about risk injecting and sexual practices for HIV and HCV among PWID. We therefore conducted this study to assess the risk practices among PWID in Uganda. We compared PWID sampled from Kampala, the only capital and central business city of Uganda, and Mbale Municipality, an urban center in Eastern Uganda.